Provider Demographics
NPI:1134429475
Name:VANTASSEL, DANA LEE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:LEE
Last Name:VANTASSEL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 ALMOND ST
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97601-1117
Mailing Address - Country:US
Mailing Address - Phone:541-885-2201
Mailing Address - Fax:541-883-1400
Practice Address - Street 1:2614 ALMOND ST
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601-1117
Practice Address - Country:US
Practice Address - Phone:541-885-2201
Practice Address - Fax:541-883-1400
Is Sole Proprietor?:No
Enumeration Date:2010-11-02
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR201050199NP363LF0000X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR157679Medicare PIN